Wiki 29888 29881 29882 advice please

[dalanicks@aol.com]

I need help and advice, dr, performed a posterior horn lateral meniscus tear, anterior cruciate ligament tear, bucket-handle tear and medial meniscus, all on the right side, - I went over the cpt codes in encoder pro and in McKesson
here they are, 29888, 29881 29822 59 - encoder pro says that you can add a modifier to 29822, I don't think that is correct, McKesson on the other hand says 29888 29882 and no to 29881- how do I know which one is more accurate, I am kinda new to orthopedic surgery and this pt. ins. is uhc, any advice would be greatly appreciated

 

[CodingKing]

You are right to question what Encoder Pro tells you what to do. Like with many of these encoders, it says you can use a modifier but doesn't give a rationale of when modifier is appropriate. All Encoder Pro cares about is that NCCI has the column 2 code listed as a 1 (modifier allowed) vs a 0 (No matter what modifier used, no payment will be made).

I don't know what McKesson software your company uses but mine goes above and beyond just modifier indicators for the column 1 and 2 codes. Many support the denial with specific sections of the NCCI manual referenced, CPT Guidelines, Clinical judgement of physicians and even better guidance by various medical societies (in case of 20000 codes, AAOS guidelines)

 

[dalanicks@aol.com]

29888 29881 29882 advice please

thank you, even the edits say not to use it and that its bundled, im gonna go with my gut and not use it, but can you or anyone recommend a great program to use when coding, i know aapc has one, i was thinking of trying that one thank s

 

[CodingKing]

Looks like UHC has a tool to check claim edits:

https://www.unitedhealthcareonline....FilesHtml/ReimbursementPolicies/CCI_2016A.pdf

Q: Why does this UnitedHealthcare reimbursement policy not contain all CCI edits?
A: CCI edits may be addressed within other UnitedHealthcare reimbursement policies and
therefore, are not included in this policy. Please refer to the Claims Estimator (available via
UnitedHealthcareonline.com) to review appropriate bundling under all UnitedHealthcare
policies.

 

[shecodes]

Given that 29881 and 29882 are for medial OR lateral compartments and these were performed in separate compartments, I would feel completely comfortable appending the modifier 59.

AAOS guidelines state that 29882 is not inclusive to 29881 when performed in separate compartments.

There are no restrictions within the NCCI guidelines that restrict this code combination.

My coding on this case, based on the information you have provided, would be 29888, 29881 and 29882-59.